ISSP-Actigraphy-Presentation2

Actigraphy: A discussion of a
non-invasive measurement of
Sleep/Wake and Activity.
Indiana Society of Sleep
Professionals
7th Annual Educational Summit
August 16, 2012
Melissa Mohr-Loeks, MPH
Clinical Trials/Research Liaison
Geriatric Sleep Research
Specialist
What is Actigraphy (Continued)
• An accelerometer creates an electrical voltage
with every movement. The bigger the
movement, the greater the voltage created.
• Actigraphy is a one dimensional method of
determining sleep/wake patterns (PSG is an
example of a multi dimensional method of
determining sleep/wake patterns).
• Actigraphy has been validated against PSG for
and generally has an accuracy of greater than
90% when worn on the wrist.
Why is Actigraphy Useful (continued)
• Actigraphy can be worn by almost all subject
populations.
• Actigraphy is an objective supplement to sleep
diaries that are known to have subject bias.
• Actigraphy is well recognized for the estimation
of sleep parameters of all age groups.
• Actigraphy does not restrict patient movement.
Actigraphy Uses
• Often, actigraphy is used to determine problems
related to sleep patterns such as circadian
rhythm or other sleep disorders.
• Actigraphy can also be used to determine the
effect of various treatments on the body.
• Cognitive Behavior Therapy for Insomnia is an
example of how Actigraphy can be used to
determine how successful therapy is for the
patient by incorporating Actigraphy with CBTI.
Actigraphy Measures:
•
•
•
•
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Normal Sleep
Insomnia
Circadian Disorder: Delayed Sleep Phase
Circadian Disorder: Advanced Sleep Phase
Circadian Disorder: Non 24 hour or nonentrained type
• Circadian Disorder: Irregular Sleep/Wake
• Shift work sleep disorder
• RLS/PLMD (when worn on the ankle)
Normal Sleeper Characteristics
• Humans typically display a pronounced
decrease in activity during rest
• Rest periods are characterized by small
intermittent movements while active periods
show significant, constant movement.
• For normal sleepers, rest and activity shown
together display a relatively stable pattern
over the 24 hour day.
• Variations may occur on weekends
Normal Sleep Actogram Example
Insomniac Sleeper Characteristics
• Rest and activity data displays an unstable
pattern, easy to see on an actogram
• Activity depicts elevated levels at just about
any time of day
• Rest periods are variable in length and timing
Insomniac Actogram Example
Circadian Disorder:
Advance Sleep Phase Characteristics
• Occurs in 1% of population and is more common in older
adults.
• ASP is typified by a sleep/wake pattern where sleep onset
and wake times are more than 3 hours earlier than normal
sleep onset.
• Sleep is typically initiated by 8 pm and the patient wakes
up very early often by 3am.
• An actigraphy record of 7 or more days can help identify
ASP patients that would be helped by interventions such
as light therapy, chronotherapy or melatonin.
• Actigraphy can track changes in the patient’s sleep/wake
pattern once these treatments have been initiated.
Circadian Disorder:
Advance Sleep Phase Example
Circadian Disorder:
Delayed Sleep Disorder Characteristics
• Occurs in 7%-16% of adolescent/young adults
• Occurs in 10% of patients with chronic insomnia
• Typified by sleep/wake pattern where sleep onset and wake
times are delayed 3-6 hours relative to normal sleep/wake
times and may be due to circadian function or behaviorally
induced sources.
• An actigraphy record of 7 or more days can help identify DSP
patients for treatment such as light therapy, chronotherapy
or melatonin.
• Actigraphy can track document changes in the patient’s
sleep/wake pattern once these treatments have been
initiated.
Circadian Disorder:
Delayed Sleep Disorder Example
Non 24 hour or Non-Entrained Free
Running Characteristics
• This is most commonly found in blind patients
• Typified by the lack of a stable relationship between
the 24-hour light-dark cycle and the circadian
pacemaker.
• Actigraphy can easily show where the rest periods
recur at a period that is greater than 24 hours
resulting in a shifting of the rest periods later each
day.
• An actigraphy record of 7 or more days can help
identify these patients for treatment with melatonin.
• Actigraphy can track changes in the patient’s
sleep/wake patterns once treatment is initiated.
Non-Entrained Free Running Example
Shift Worker
Sleep Disorder Characteristics
• Typified by altered patterns of sleep/wake in
order to work at jobs with variable hours.
• Actigraphy can track these patterns.
• Actigraphy easily shows the fragmentation of
consolidated sleep periods surrounding shift
changes.
• “Weekends” and days off are easily identified
by definite changes in sleep/activity patterns.
Shift Worker Example
Pediatric Sleep Actogram
Reimbursement information
• General coverage guidelines:
Actigraphy studies may be covered for the
diagnosis and treatment of sleep disorders.
 Coverage and reimbursement for actigraphy
services still vary by payer.
CMS has not yet issued coverage guidelines
for Actigraphy.
Reimbursement (continued)
• Coding guidelines:
 Actigraphy services are currently using a
Category I CPT code.
 As the case with newly established codes, some
payers may not recognize this code and provide
instructions on alternate or potentially outdated
coding guidelines.
 It is important to submit claims using the new
Category I CPT code 95803 for reporting
actigraphy services.
CPT Code Additional Information
• Actigraphy, testing, recording, analysis,
interpretation and report (minimum of 72-hours
to 14 consecutive days).
• There are additional codes that may be used to
report actigraphy-related services (available
upon request).
• It is recommended that healthcare providers
verify recommended coding guidelines with
payers prior to submitting claims for these
services.
Types of currently available
actigraphy devices for sleep monitoring
Actigraphy Summary
• Benefits are:
– Screens for sleep disorders
– Cost benefit
– Ease of use
– Objective measure of sleep/wake
– Ambulatory, long-term data collection
– Reliable
– Validated with PSG
Conflict of Interest Disclosure
__x__I do not have any potential conflicts of interest to disclose,
OR
____I wish to disclose the following potential conflicts of interest:
Type of Potential Conflict/Details of Potential Conflict
____Grant/Research Support
____Consultant
____Speakers’ Bureaus
____Financial support
____Other
Questions?